Healthcare Provider Details

I. General information

NPI: 1912186677
Provider Name (Legal Business Name): ELDERWOOD HEALTH CARE AT TIOGA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 N CHEMUNG ST
WAVERLY NY
14892-1211
US

IV. Provider business mailing address

37 N CHEMUNG ST
WAVERLY NY
14892-1211
US

V. Phone/Fax

Practice location:
  • Phone: 607-565-6329
  • Fax: 607-565-6314
Mailing address:
  • Phone: 607-565-6329
  • Fax: 607-565-6314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DARLENE GALE
Title or Position: DIRECTOR OF ACCOUNTS RECEIVABLE
Credential:
Phone: 716-250-1150